In the first quarter of 2010, Howard Brown Health Center (HBHC) announced that the agency was in a financial crisis, following an alleged mismanagement of funds. Not long after, as a result of pressure by community members, the agency announced that it would have a full revamping of the board by July 1, 2011.

At this time, except for two members who joined after news of the alleged mismanagement, the new board has been reconstituted with 20 members plus CEO Jamal Edwards in an ex officio capacity. In the wake of the controversy surrounding what Edwards said could have been the closing of doors and services, the agency widely promised drastic new changes and a new era of transparency.

While information was initially forthcoming, recent events indicate that HBHC may be returning to its former days of closing itself off from the LGBT media and community.

HBHC has long had a history of contentious and secretive boards. In light of recent developments and the severity of the situation in which the organization finds itself, this paper has sought to find out how the board is involved in sustainable ways to move forward. Windy City Times and the community have asked what the role of the board might have been in terms of overseeing the alleged mismanagement of funds.

The effort to constitute an entirely new board began this spring and Ron Nunziato, who was part of the organization's board several years ago, was named to oversee the process. WCT spoke to Nunziato recently to find out more about the new board, and asked about the key issues involved in constituting it. He responded, "The charge was to find people that were at the leadership level, in experience or skill set. Senior-level experience in healthcare, business and finance were three key components [we sought]."

Nunziato explained that there was a second set of priorities, that people have experience in matters like public relations, marketing, fundraising and government, but the first three were the most important.

The consulting company Executive Service Corps (ESC), which describes itself as a "provider of capacity-building programs and services for non-profits and public agencies," was "charged with putting together the board orientation," according to Nunziato, after his independent committee put it together. He said that ESC's responsibility was to help new board members understand, for instance, HBHC's financial statements. He added that Karma Israelsen, the new board chair, would have been responsible for ESC's contract. ESC's function ended after the board orientation.

Currently, HBHC is accredited as a Federally Qualified Look-Alike, but is not yet a Federally Qualified Health Center (FQHC). A Look-Alike can get Medicare and Medicaid reimbursement and some other benefits, but does not receive grant funding. One great advantage to becoming a fully qualified FQHC is that new ones can request up to $650,000 in grant funding (which is not guaranteed).

According to Edwards, HBHC has applied to become a full FQHC.

One requirement of Look-Alikes and FQHCs is that their boards "must include a majority (at least 51 percent) of active, registered clients of the health center who are representative of the populations served by the center," according to the Rural Assistance Center, an "information portal" of the U.S. Department of Health and Human Services' Rural Initiative. (The information is also pertinent to urban areas.) This requirement may be waived under certain circumstances, such as if the organization serves primarily migrant or homeless populations.

WCT asked Ron Nunziato if the independent group putting together the board had worked to ensure the 51 percent. He responded, "There were questions from the nominating committee to all the candidates about using Howard Brown health services, with a number of candidates confirming they did use the health center's services." Asked if 51 percent did so, he said, "I would be uncomfortable discussing this any further because I felt as though the process of the requirement is in direct conflict with HIPPA [the 1996 Health Insurance Portability and Accountability Act] violations of patients' privacy. It's very conflicting that we have a national regulation called HIPPA, which is a privacy act of patient confidentiality, and yet we're asking people where they use health services and what services of Howard Brown. So, we did ask people if they had used the services."

Asked again if that was 51 percent, given that this is a federal requirement, Nunziato said that he did not have his notes in front of him and added, "It's a federal directive. However, as a healthcare compliance officer, I find it difficult to go down that road of ensuring that the requirement is met."

Via email, we asked Jamal Edwards if the 51-percent requirement was fulfilled. However, he did not respond directly to the question, only stating that the agency was seeking FQHC status.

One of the biggest controversies surrounding HBHC has been its accountability as a community-based health center, and one of the many ways in which it has launched its massive and ongoing appeal to make its $1 million fundraising goal has been to insist that it functions to serve the LGBTQ community. In that context, ensuring that the board meets all federal requirementsif it is indeed bound by them, and there is so far no indication that it is notwould seem to be key, as would ensuring that a new board be representative of the community it serves.

HBHC has had a long and contentious history with its boards, with several turnovers and CEOs often retreating behind a wall of silence during crises. Its most recent crisis, which supposedly brought the agency to the brink of closure, raised questions about the extent to which board members may have overseen, suspected, or known about the issues which led to the mismanagement. WCT has asked, several times, for an interview with Karma Israelsen, the new board chair, but has not received one so far.

Sources have informed WCT that Edwards has effectively banned communications between board and staff members, and WCT asked about that as well in the email to Edwards. Several sources have indicated that staff are unhappy about their inability to ask questions or express dissent about changes, such as staff turnover or shifts in focus at the organization.

In response to our query, Edwards wrote, "... what you have heard is inaccurate. It is a responsibility of the CEO to serve as the conduit between the board and staff and to manage the day-to-day business, which is the practice at HBHC. It would be highly unusual for any organizationnonprofit or for profitto have unchecked staff outreach to directors of the institution's board, or vice-versa. But that said, HBHC's board and senior staff members have healthy and regular interactions and are working collaboratively through our revitalization. HBHC senior staff are very involved with our board including playing a key role in helping orient and support the newly elected board members, and our senior staff also work closely with board committees and are actively and directly involved in the strategic planning process we recently began."

However "senior staff" does not necessarily constitute "staff," and WCT's attempts to gain further insight into the matter have been met by Edwards' further statement to the paper that "... we will no longer engage in distracting, unhealthy and unproductive dialogue. Going forward, we will respectfully decline any further comment on the hearsay, speculation and innuendo of our detractors and disgruntled former members of HBHC who seem to want the WCT to carry their cause."

Edwards continued, "We will instead continue to direct our energies and attention to serving the thousands of people we are called to serve. Accordingly, please consider these responses our last and final comment on these matters. We sincerely hope the WCT will look forward with us and will discontinue the unhelpful negativity and gossip. To that end, we will continue to engage in healthy transparency by sharing press releases and periodic updates on our forward progress, and will continue to engage with those media and press who are open to productive dialogue and keeping our community informed about our progress and, importantly, the positive impact our hard work continues to have on the growing availability of the necessary and critical health, wellness and research services provided by HBHC, the LGBTQA community's lifeline."

While Edwards claims that "former" staff members are speaking out, WCT has interviewed dozens of people for this series on HBHC, and many of them are current staff members who are fearful of their jobs if they come forward with complaints. True transparency would mean they would be allowed to air their grievances without fear for their jobs.

WCT spoke to Norman Silber, professor of law at Hofstra University, who researches and writes on nonprofits, for background on how such organizations work with such issues. Silber, speaking generally and not about HBHC in particular, said that there has been some backlash against non-profits in general and greater calls for accountability and transparency: "What's happened to nonprofits over the last decade and a half is that more and more of their revenue is generated not from donations but from fees for service, not even from grants, and that's especially the case in the healthcare sector. As that has happened, non-profit boards are functioning more and more the way for-profit boards do, with more secrecy and less consultation with advisory boards and other groups, for example."

He explained that the calls for more transparency occur within changes in the commercial environment in which such organizations find themselves, and such calls are "at odds with the growing imperative that the managers of the nonprofits see, which is: they're in a competitive environment in which they compete against for-profit organizations and other very aggressive non-profits that operate very much on a business model. In that climate, the law is in flux, so you see in the academic world a contest over what the appropriate set of legal rules ought to be, for board governance."

With regard to the issue of boards that may have limited communications between staff and boards, Silber said, "You'd have to think about the quality of decision-making, and whether or not organizations and boards that operate in a bubble actually make decisions of poorer quality than boards that operate with a lot more communication between their management and their boards. And if you create a funnel where the only person who speaks to the management is the executive director or the chairman of the board, then the question is: how informed are the other board members about what's really going on?"

For its part, WCT will continue to email questions to HBHC, in the interest of providing every response to the many questions that come up about the agency's future.

Future installments will continue to look at board issues, specifically in relation to Illinois laws, as well as funding and service matters.

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